Fact checking the first debate

byRob CullenonOctober 8, 2012

The reaction from pundits was unanimous: Mitt Romney won the first Presidential debate. We couldn’t help but notice though that Romney, while sounding smoother than we’ve ever heard him, seemed to be, well… making a lot of stuff up. Of course, President Obama got some things wrong too, but articles with titles like “Obama and Romney both strayed from facts” aren’t very helpful. They don’t give an accurate picture of the debate if one candidate goofed on some numbers while the other candidate was lying his face off.

And so, to get some perspective, we went back to the transcript, and fact-checked every healthcare claim made by either candidate. In the interest of space (and our sanity), here are just the claims that turned out to be false or misleading in some way. Turns out one candidate was overwhelmingly dishonest.

ROMNEY: “I would like to take the Medicaid dollars that go to states and say to a state, you’re going to get what you got last year plus inflation — inflation — plus 1 percent.”

Meanwhile, restoring Obamacare’s “$716 billion in Medicare cuts” [see below] would actually increase premiums and copays for seniors by several hundred dollars a year. The Incidental Economist’s Aaron Carroll has a great post explaining why, but it basically comes down to the fact that seniors pay a percentage of their coverage. If the total cost of covering each senior rises– and it would if those “cuts” were restored– the amount each senior pays increases as well.

ROMNEY: “On Medicare, for current retirees [Obama’s] cutting $716 billion from the program” to pay for Obamacare.

MISLEADING: For one thing, Paul Ryan’s budget makes the exact same cut to Medicare, and less than a year ago, Romney was saying President Obama should sign it. The statement also gives the impression that benefits are being taken from current recipients. Here’s where the savings actually comes from:

ROMNEY: “I want to take that $716 billion you’ve cut and put it back into Medicare.”

MISLEADING: The problem with Romney saying he’ll restore that Medicare funding is that then his own budget numbers don’t add up, as The New Republic’s Jonathan Cohn explains:

Remember, he’s promised to cap non-defense spending at 16 percent of GDP. And he’s said he won’t touch Social Security. If he walls off Medicare, too, that would mean even sharper cuts across the board. How sharp? The Center on Budget and Policy Priorities ran the numbers. If Medicare is getting that $716 billion back, he’d have to cut other programs by an average of a third by 2016 and in half by 2022. Non-discretionary defense spending, which “has averaged 3.9 percent of GDP and never fallen below 3.2 percent,” would fall to 1.7 percent.

That’s simply not realistic. I have no problem believing Romney would cut domestic program deeply; his willingness to endorse the kinds of cuts he has specified, to Medicaid and food stamps, tell you everything you need to know about his priorities. But these figures are the stuff of fantasy. Either Romney can’t restore the Medicare dollars as he says or he’s not living up to his promises on deficit reduction.

ROMNEY: “We also have 50 percent of doctors who say they won’t take more Medicare patients.”

FALSE: In a recent survey of doctors, only 17% said they weren’t taking new Medicare patients. By the way, that’s more doctors taking new Medicare patients than any other form of coverage– in the same survey, 18% of doctors said they weren’t taking new patients with private insurance.

ROMNEY: “We have 4 million people on Medicare Advantage that will lose Medicare Advantage.”

MISLEADING: The Affordable Care reduces over-payments to the insurance companies who provide Medicare Advantage. (In 2010 Medicare Advantage plans cost 17% more than traditional Medicare, driving premiums up for all beneficiaries.) Insurance companies can’t afford to provide some Medicare Advantage plans without those extra payments– the Medicare Trustees estimate that 4 million seniors will be affected.

more seniors are enrolled in 4 or 5 star plans (thanks to the new law’s bonuses for plans that achieve high quality rankings)

OBAMA: “The idea, which was originally presented by Congressman Ryan, your running mate […] would cost the average senior about $6,000 a year.”

MISLEADING: Obama is referring to Paul Ryan’s 2011 budget proposal, which would covert Medicare to a voucher system. These vouchers would grow at the rate of inflation, which rises much more slowly than the cost of healthcare, and so in 2022 Ryan’s plan would shift an extra $6,000 in Medicare costs onto the average senior.

However, Ryan’s 2012 budget proposal is a little different— it’s still a voucher program, but the voucher would keep up with the growth of health care costs (according to the CBO, this new plan doesn’t save the government much money though). Romney’s plan resembles Ryan’s second proposal, which would not shift $6,000 onto seniors.

ROMNEY: “When you look at ‘Obamacare’, the Congressional Budget Office has said it will cost $2,500 a year more than traditional insurance.”

MISLEADING: Romney’s leaving a lot out here. First, in that report, the CBO found that the cost of insurance provided by small business and large employers would come down slightly under Obamacare. On the individual market, the CBO did expect premiums to rise by $300 for individuals, and by about $2100 for families… an increase of 10% to 13%.

But that’s not the entire story. For one, the CBO expects more members of each family to get coverage, which is part of the reason family premiums will rise. The CBO also points out that Obamacare will bring down the cost of premiums for families by lowering administrative costs and by bringing healthier people into the risk pool. The reason premiums will go up on the individual market is that families will get a greater amount of coverage. Or as Ezra Klein put it:

Add it all together and we’re looking at a 10 to 12 percent increase in premiums for insurance that’s about 30 percent better than what people are getting now. And all this is before we get to subsidies.

Speaking of subsidies– more than half of all Americans buying their own insurance will qualify for some kind of subsidy. For those that qualify, the CBO estimated that their premiums would be 56% to 59% lower under Obamacare on average.

[If you want to learn more, we did an entire post on this a while back.]

ROMNEY: “[Obamacare] puts in place an unelected board that’s going to tell people ultimately what kind of treatments they can have.”

FALSE: The new law does create a board to submit a proposal to Congress every year with recommendations on how to reduce Medicare costs. However it explicitly states that the board can’t recommend limiting treatment options. From section 3403 of the law:

ROMNEY: “There was a survey done of small businesses across the country. It said, what’s been the effect of “Obamacare” on your hiring plans? And three-quarters of them said, it makes us less likely to hire people.”

That statistic was based on an online, opt-in survey of small-business executives. A press release from the Chamber of Commerce [which opposes the health care law and has run numerous TV ads attacking it] about the survey carries a large caveat: “This online survey is not based on a probability sample and therefore no estimate of theoretical sampling error can be calculated.” In other words, the chamber can’t be sure it’s a representative sample of small-business executives.

Those kinds of surveys can be useful for marketing research purposes, said Scott Keeter, director of survey research at the Pew Research Center and the most recent past president of the American Association for Public Opinion Research. “But from the point of view of public policy decisions, they tend not to be given much credence.”

“The bottom line is that surveys that have self-selected samples don’t have any known relation to the target group [in this case small-business owners],” Keeter said. “As a result, it is difficult, if not impossible, to know what kind of weight to give this.”

That is why, Keeter noted, that major news organizations like the Washington Post, New York Times and ABC News have strict policies prohibiting the reporting of such surveys.

ROMNEY: “[Health reform] has killed jobs.”

What the CBO actually said is that the impact of the health care law on supply and demand for labor would be small. Most of it would come from people who no longer have to work, or can downshift to less demanding employment, because insurance will be available outside the job.

“The legislation, on net, will reduce the amount of labor used in the economy by a small amount– roughly half a percent– primarily by reducing the amount of labor that workers choose to supply,” budget office number crunchers said in a report from last year.

MISLEADING: It’s true Romney didn’t raise taxes to pay for health reform, but only because (1) the taxes that paid for Massachusetts’ health reform were already in place when he was elected; and (2)Massachusetts gets an extra pot of federal money that other states do not get.

The Washington Post’s Sarah Kliff has a fantastic article looking at how Massachusetts used not just federal Medicaid money, but “federal dollars above and beyond that Medicaid money to finance their health reforms.”

ROMNEY: “The CBO says up to 20 million people will lose their insurance as Obamacare goes into effect next year.”

FALSE: Back in March, the CBO along with the Joint Committee on Taxation did do a study looking at how the law would impact the number of people getting insurance from their employer. Here’s what it actually said:

In CBO and JCT’s judgment, a sharp decline in employment-based health insurance as a result of the ACA is unlikely.

So where does Romney get 20 million people from? Well, in the report the CBO points out that there’s some uncertainty about how employers will react to Obamacare. To cover all their bases, they provide estimates for a number of alternative scenarios– and in the most extreme scenario 20 million fewer people would get employer coverage. But the CBO doesn’t think that’s likely– if anything, it may go the other way. Again, from the actual CBO report:

Surveys of employers regarding their plans for offering health insurance coverage in the future have uncertain value and offer conflicting findings. One piece of evidence that may be relevant is the experience in Massachusetts, where employment-based health insurance coverage appears to have increased since that state’s reforms, which are similar but not identical to those in the ACA, were implemented.

Besides being wrong about the number, Romney’s also wrong to say that employees will “lose” coverage. From PolitiFact:

According to CBO’s “baseline” estimates [i.e. not Romney’s cherry-picked alternative scenario], 3 million people will spurn their employer’s offer of insurance and turn instead to another source, such as the health insurance “exchanges” created under the Obama health care law. In many cases, they will do this because they consider the employer’s offering to be unaffordable or lacking too many features they need.

ROMNEY: “And likewise, a study by McKinsey and Company of American businesses said 30 percent of employers are anticipating dropping people from coverage.”

MISLEADING: After a number of anonymous McKinsey employees cast doubt on the study, the company clarified that it was not meant to be a “predictive economic analysis.”

The Urban Institute: “Overall employer-sponsored insurance coverage under the ACA would not differ significantly from what coverage would be without reform.”

Mercer: “In a survey released today by consulting firm Mercer, employers were asked how likely they are to get out of the business of providing health care once state-run insurance exchanges become operational in 2014 and make it easier for individuals to buy coverage. For the great majority, the answer was ‘not likely.'”

So while it’s true that 30% of respondents said they may drop coverage as a response to the Affordable Care Act, we marked this claim as misleading because every other reputable study found (and McKinsey later admitted) that employers are unlikely to actually do that.

OBAMA: “Over the last two years, health care premiums have gone up — it’s true — but they’ve gone up slower than any time in the last 50 years.”

FALSE: As the AP pointed out, “Obama is mixing overall health care spending, which has been growing at historically low levels, and health insurance premiums.” This year’s 4% increase in premiums was low compared to recent years, but last year the increase was a relatively high 9%.

ROMNEY: “Pre-existing conditions are covered under my plan.”

FALSE: This claim was so obviously wrong that Romney’s senior adviser Eric Fehrnstrom walked it back minutes after the debate, telling reporters that Romney was actually referring to existing laws that require insurance companies to sell coverage to people who already have insurance. As for people who can’t get insurance in the first place, because of pre-existing conditions:

Pressed by TPM’s Evan McMorris-Santoro, Fehrnstrom said those who currently lack coverage because they have pre-existing conditions would need their states to implement their own laws — like Romney’s own Massachusetts health care law — that ban insurance company from discriminating against sick people.

“We’d like to see states do what Massachusetts did,” Fehrnstrom said. “In Massachusetts we have a ban on pre-existing conditions.”

In other words Romney’s “plan” to cover pre-existing conditions is to (1) repeal Obamacare, the law banning pre-existing conditions, and then (2) hope that states pass their own laws banning pre-existing conditions.

ROMNEY: “Young people are able to stay on their family plan. That’s already offered in the private marketplace; you don’t have — have the government mandate that for that to occur.”

FALSE: Before Obamacare, many insurance plans did not let young adults remain on their family’s insurance plan once they lost their status as dependents, or soon after. Because of the new requirement, 3.1 million young adults have gained coverage.

OBAMA: “It’s estimated that by repealing ‘Obamacare’, you’re looking at 50 million people losing health insurance.”

WRONG NUMBER: The CBO estimates that about 32 million people will gain insurance as a result of Obamacare, not 50 million. However, if you add the effect of all Romney’s health policies together (repealing Obamacare, cutting Medicaid, etc.), 46 million fewer people will have coverage than under Obama, according to a study by the nonpartisan Commonwealth Fund.

ROMNEY: “The federal government taking over health care for the entire nation and whisking aside the 10th Amendment…”

FALSE: PolitiFact awarded the reference to Obamacare as a “government takeover of healthcare” its Lie of the Year award in 2010. It’s really a judgment call as to how much government involvement constitutes a “government takeover,” but a system like the Affordable Care Act– the largest expansion of private insurance ever– is nowhere close.